Barriers to Healthcare Access Among Refugees with Disabilities and Chronic Health Conditions Resettled in the US Midwest

Abstract

Chronic conditions and related functional disabilities are highly prevalent among resettled refugees in the United States. There is a need to explore this population's access to appropriate healthcare services in order to identify service disparities and improve interventions. Using a community-based participatory research approach, semi-structured interviews were conducted with key informants to identify healthcare access barriers affecting disabled and chronically ill refugees. Eighteen participants were interviewed, revealing three main barriers: (1) inadequate health insurance, (2) language and communication barriers, and (3) a complex maze of service systems. These barriers were found to operate at systems, provider, and individual levels. Broad-based policy and practice interventions are required to address barriers including: an expanded pool of medical interpreters, peer navigators, innovative health information technologies, and greater collaboration and information-sharing between service systems. Further research is needed to monitor the impact the Affordable Care Act on service access of refugees with disabilities and chronic conditions.

Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

“…2 Primary care providers experience significant challenges in caring for refugees. Insufficient time to address refugees' needs is particularly difficult given that refugee populations are often unfamiliar with the concepts of prevention and long-term treatment of asymptomatic conditions and require greater amount of time for health education.…”

Physical Activity Education for Adults with Refugee Background in the United States

“…Social factors, such as socioeconomic influences, limited language proficiency, acculturation process, and cultural incompetency in healthcare services created barriers that prevented immigrants from maintaining a healthy lifestyle [9]. Foreign-born groups also perceived difficulties in navigating the US healthcare system, leaving any untreated diseases or conditions worsen over time [10]. The combination of individual-and social-risk factors resulted in increased occurrence and prevalence of chronic noncommunicable diseases associated with duration of residence in the US [3,4].…”

“…Over one million refugees resettled in the US in the past decade, and most of them were exposed to traumatic events that posed long-term impacts on their mental health [11]. Many refugees also suffered from starvation, malnutrition, infectious diseases, and severe pain and injuries as a result of their turbulent migration experience [10]. Initial health screening at the time of arrival in the US revealed that refugees were in compromised health status with poorer health indicators compared to other immigrant categories [4].…”

Assessing Geospatial Barriers in Refugee Resettlement Communities: A Descriptive Exploration about How to Identify the Health and Other Resource Needs of Recently Resettled Refugee Women

“…[2][3][4][5][6] Additionally, unlike many receiving nations, the United States prioritizes the admission of refugees with significant health concerns, further creating populations with pervasive and unique health care needs. [5][6][7] While all refugees face significant barriers in resettlement, there is evidence to suggest that women may be particularly burdened by forced 2 According to a 2008 report by the United Nations High Commissioner for Refugees, the outbreak of conflict and subsequent displacement exacerbates already existing gender inequalities, resulting in a disproportionate strain on women's health. 8 To address the health concerns of this vulnerable population and to ease transition into the American health care system, refugees are granted the same health care rights afforded to United States citizens and receive a brief period of public health insurance.…”

“…Common barriers identified in recent studies include language barriers, difficulty finding the appropriate provider for specific needs, lack of awareness about health care services and their functions, financial restraints, concerns about confidentiality, the stigma of being diagnosed with certain diseases, and a lack of culturally competent care, including appropriateness of interpreters. 3,5,9,10,11 Of particular concern is the inability of many refugee women to overcome the geographic barrier of accessing healthcare. As noted by Garfield, women view their geography in terms of landmarks and rely more on 3-D visualizations, such as buildings and/or natural structures.…”